preemies
Mamas on Bedrest: 1st Time Mamas over 45 Can Expect Complications
April 19th, 2011Being an older mama myself, I am always a bit sensitive when I see reports indicating the problems and complications associated with being an older mama. So when I read this Reuter’s Health Report on Medscape my heart went out to older women desiring to and having children.
I want to add that while this report states that pregnancy is more risky for older moms, in this case, having their first child over the age of 45, it’s not impossible. Even if a woman is not able to carry her own child, there are surrogates (women who will donate an egg to a pregnancy and then carry the pregnancy) as well as gestational hosts (women who will carry a child for a couple) and adoption. Older women can have the children their hearts desire.
The study was conducted in Israel and found that pregnancy and childbirth in Israeli women over age 45 has nearly tripled over the last decade. The study looked at 131 mothers ranging in age from 45 to 65 who gave birth between 2004 and 2008. Forty percent developed gestational diabetes and 20% had preeclampsia. One third of the babies were born prematurely and nearly all were delivered by cesarean section. All but 5 of the women had become pregnant with assisted reproductive technologies.
Why is it so much more difficult to have a child, especially a first child, over that age of 45? First and foremost there are the physiological changes going on with a woman. If a woman has never been pregnant, the quality and number of eggs that her ovaries will produce will be lowered. At 45 years old many women are approaching menopause and their bodies are responding to hormonal fluctuations. In particular, she may have uterine changes such that she is unable to sustain a pregnancy. Women are also at risk of having developed hypertension and Type II diabetes by age 45. Researchers in this study recommend counseling against pregnancy if an older woman already has a pre-existing condition.
While the researchers acknowledged the increased risk to older mothers and their babies (increased risk of being born prematurely, at a lower birth weight, requiring intensive care in NICU and having developmental problems) they did not make being over age 45 and absolute contraindication to attempting pregnancy.
I can attest to the fact that the older you are having children, the more risk there is to you and your baby. My first pregnancy at age 35 ended in miscarriage. The second was high risk, fraught with complications and resulted in my daughter being born at 36 weeks and 6 days at 5 lbs 3 oz. I miscarried my 3rd pregnancy at age 38 and had my son, my 4th and last pregnancy at 40 yrs and 4 months. So I was not as old as the women in the study in Israel yet did experience more complications than women say 5-10 years younger than I was at each age. If I had it all to do over again, would I? Absolutely, but I have to admit that I would do it a lot smarter.
Before each pregnancy I would engage in a 3 month pre-conception “conditioning program” where I’d take exquisite care of myself; priming my body with exceptional herbs and supplements, getting lots of rest, making sure that I was at ideal body weight for my height and that I was fibroid free. In preparation for complications, I’d have a support system in place-either my mother, mother in law or friends in the community at the ready and available to assist me with my activities (especially with my second/fourth pregnancy with my son where I had a 3 1/2 year old to take care of as well).
As the saying goes, hindsight is 20/20. I didn’t do any of these things, but I made it my mission to do for other women what I did not do for myself and hence Bedrest Fitness and Mamas on Bedrest & Beyond were created. If you are an older woman and have decided to pursue pregnancy, we would love to support you in your endeavors. So that we can assist you to plan your pregnancy and (hopefully ) avoid bed rest or at the very least, minimize the trauma/drama, sign up for a Complimentary 30 minute Bedrest Breakthrough Session. We’ll go over potential pitfalls of being an older pregnant mama and offer tips to minimize them.To schedule, send an e-mail to info@mamasonbedrest.com.
While complications are expected the older a mama is having her babies, they aren’t mandatory and they don’t have to be horrendous. As researchers in the Israeli study pointed out, “Starting motherhood at an advanced age may carry risks, but they’re not prohibitive risks. People of all ages are interested in having a child and completing their families.”
Bedrest Coach Darline Turner-Lee had her daughter at age 37 and son at age 40.
Nifedipine in the Management of Preterm Labor
March 11th, 2011
I am always excited to see new medications and treatments for the treatment of preterm labor and management of high risk pregnancy complications. It is my ever present hope that one day there will be no need to put mamas on bed rest. (Yes, I do hope to put myself out of business in this capacity!) But until that day comes, we need all the help that we can get.
Yet I get a bit nervous when physicians and researchers start shifting and changing medications and using a medication indicated for one ailment for something else-”off label”. Recently, researchers at the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Perinatology Research Branch, National Institutes of Health, Department of Health and Human Services published a paper stating that Nifedipine, a calcium channel blocker used to lower blood pressure, is a useful tocolytic (anti-contraction) medication for the management of preterm labor. Nifedipine has been used to prevent preterm labor for many years and these researchers sought to determine its efficacy and how it stacked up against other routinely prescribed tocolytics.
Nifedipine is a cardiac medication. I first became acquainted with Nifedipine when I was a newbie physician assistant working with an interventional cardiology group. Many of our patients were on Nifedipine for high blood pressure as well as for aginal chest pain. Nifedipine works by relaxing the smooth muscle of the heart so that it is not pumping so hard. This relaxation allows for more blood to flow through the heart and to the rest of the body, providing more blood, nutrients and oxygen to the body. Because the muscles of the heart are relaxed and there is more oxygen available and delivered to (cardiac) cells, chest pain is relieved.
Nifedipine has a similar mechanism of action on the uterus. Preterm labor is premature contractions of the uterus that can lead to premature delivery. Just as Nifedipine relaxes smooth muscles in the heart, it also relax smooth muscles of the uterus slowing or halting contractions and avoiding preterm labor and delivery. Researchers found that Nifedipine was more efficacious in halting preterm labor contractions than many other tocolytics used, most notably Magnesium Sulfate, a mainstay of preterm labor therapy. Additionally, it was better tolerated by women who used it and women reported having fewer adverse reactions compared to the other medications. So it sounds like Nifedipine is a win win all around.
How will side effects routinely experienced by cardiac patients affect pregnant women? In the cardiac practice, the most common side effects that I saw were headaches, dizziness and flushing. Translating that to pregnant women, who may or not have high blood pressure, are we at risk of “bottoming out” their blood pressure? (Meaning, if they don’t have high blood pressure yet take the medication, will their blood pressures drop too low causing dizziness or fainting?) Women on bed rest, who are already de-conditioned and wobbly, will they be at increased risk for falls?, How about constipation and heartburn, already problematic during pregnancy, yet increased with administration of nifedipine?
Many would readily say that the risk of delivering a premature infant far outweighs the risks of developing so called “nuisance” side effects. However calcium channel blockers, the class to which Nifedipine belongs, are also known to slow heart rate, and are frequently used for patients experiencing atrial (top of the heart) arrhythmias. Now most mamas on bed rest are not experiencing arrhythmias, yet may still experience a slowing in their heart rates. Is Nifedipine transferred to the developing fetus? If so, what effect will it have on fetal heart rate? According to the article, many of these side effects were not experienced by pregnant women taking Nifedipine for preterm labor.
When Nifedipine was given to pregnant women experiencing preterm labor, the women (actually their infants) had significantly reduced incidences of respiratory distress syndrome, necrotizing enterocolitis, intraventricular hemorrhage, neonatal jaundice, and admission to the neonatal intensive care units. Nifedipine was also associated with a significant reduction in the risk of delivery within 7 days of initiation of treatment and before 34 weeks’ gestation. Mamas also experienced fewer adverse side effects compared with Beta Adrenergic Receptor Agents and Magnesium Sulfate.
So is Nifedipine the next great thing for the prevention of preterm labor? Perhaps. At the very least, it affords physicians and pregnant women another option for treatment while sparing infants potentially serious side effects.
Mamas on Bedrest: Please Consider Donating Breast Milk-If You Can
February 18th, 2011I had the great pleasure to tour the Mother’s Milk Bank Austin this week and then interview the Executive Director, Ms. Kim UpdeGrove, CNM, MSN, MPH. I learned a tremendous amount about the importance of breast milk in the care and development of the most fragile infants-premature infants and infants born with congenital abnormalities or illnesses or diseases. I also learned that for the infants who need it most, human breast milk is in fretfully short supply. The 10 milk banks across North America desperately need more milk to be able to meet the needs of premature and fragile infants, and more milk can only come from more donors.
The greatest benefits of human breast milk are that it is specifically designed to contain the right nutrients, the right amount of calories and the right immune agents to fight disease specific to human infants. Human breast milk naturally changes and adapts so that at each stage, the infant is receiving the right nutrients for healthy growth and development.
The most common complication to fragile infants is necrotizing enterocolitis. This infection damages infants’ delicate intestines so quickly and often so severely that up to 62% of babies die and the remainder face lifelong complications. Infants who receive breast milk, either from their mothers or from donors, have a dramatically reduced risk of developing this deadly infection.
You can become a breast milk donor in 4 easy steps: (The Mother’s Milk Bank Austin Intake Information. Other milk bank information may vary slightly)
- Complete a 10-15 minute phone screening.
- Complete and return an informational packet.
- Have a blood test done. (In Austin, The Milk Bank pays)
- Approval once all information is in, reviewed and approved.
As previously stated, there are 10 Milk Banks in North America, one in Canada and 9 in the United States.
British Columbia, California, Colorado, Indiana, Iowa, Michigan, North Carolina, Ohio, Texas (Austin),Texas (North). Milk Banks are being established in Ontario Canada, Florida, Mississippi, Missouri New England, Oregon. Hopefully one day there will be a milk bank in every US state, all across Canada and in Mexico. There are Milk Banks in many other countries.
All of the milk banks adhere to the guidelines for human milk storage and safety established by The Human Milk Banking Association of North America.
HMBANA is the only professional membership association for milk banks in Canada, Mexico and the United States and as such sets the standards and guidelines for donor milk banking for those areas. It was founded in 1985 to:
- Develop guidelines for donor human milk banking practices in North America
- Provide a forum for information sharing among experts in the field on issues related to donor milk banking
- Provide information to the medical community regarding use of donor milk
- Encourage research into the unique properties of human milk for therapeutic and nutritional purposes
- Act as a liaison between member banks and governmental agencies
- Facilitate communication among member banks to assure adequate distribution of donor milk
- Facilitate the establishment of new donor milk banks in North America using HMBANA standards.
Donor Human Breast Milk is processed in highly scientific fashion. The milk is measured, analyzed, sterilized and exquisitely mixed so that it is the precise formulation for babies at each age, size and developmental stage. “Follow The Milk” to learn more about the process of preparing donor breast milk.
There is so much that needs to be done. If you can donate breast milk, volunteer or make a financial contribution, any and all support is greatly appreciated. To get more involved, contact a Milk Bank in your area. If there is not a milk bank in your area or if you are unsure of how you can help or where, send e-mail to info@mamasonbedrest.com and we will gladly get you to the right people.
Below left, my daughter at 2 days old, born at 36 wks, 6d. She got some donor breast milk until my milk came in. Below right, my daughter today, age 8.
